The Skeleton Key: Will the Federal Health Care Reform Legislation Unlock the Solutions to Diverse Dilemmas Arising from the State Health Care Reform Laboratories?

Given that the Reform Law is not operating on a blank slate, this article examines its impact on the health care reform efforts of three states: Hawaii, Maine, and Vermont. More specifically, this article examines each state’s health care reform plan, the outcomes of each plan in terms of achieving universal coverage or near universal coverage, and the likely impact of the federal health care reform legislation on these plans, with a particular focus on how the federal legislation and state laws will or will not work together to achieve near-universal coverage. The article aims to determine whether the Reform Law unlocks the solutions to some of the dilemmas resulting from state health care reform efforts, or whether the Reform Law fails to do so or even exacerbates existing problems. This article focuses on the health care reform efforts of Hawaii, Maine and Vermont for three reasons. First, each of the three states has taken different approaches toward achieving universal coverage. Second, all three rank highly in terms of their low rate of uninsured residents, but have yet to achieve near-universal or universal coverage. Third, Maine and Vermont were chosen because the Kaiser Family Foundation has identified those two states as two of three states, Massachusetts being the third, which have enacted universal health care coverage legislation.